Predictors of depression and suicidal behaviors among in-school adolescents in Nigeria: A Cross-sectional Study

Predictors of depression and suicidal behaviors among in-school adolescents in Nigeria: A Cross-sectional Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Predictors of depression and suicidal behaviors among in-school adolescents in Nigeria: A Cross-sectional Study Isabella G. IGHAEDE-EDWARDS, Idriss François NTSAME ALLOGO, Xiaoqun LIU, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5751576/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Aim: This study investigates the prevalence and determinants of depression and suicidal behavior among secondary school adolescents in Edo State, Nigeria. Subject and Methods: A descriptive, cross-sectional study was conducted with 621 in-school adolescents, selected through multistage random sampling. Depression and suicidal ideation were assessed using the Patient Health Questionnaire-9 (PHQ-9) and Suicidal Behavior Questionnaire-Revised (SBQ-R). Statistical analyses, including chi-squared tests, Fisher’s exact tests, and logistic regression, explored correlations, with significance set at p < 0.05 Results: Among participants, 26.09% reported mild depressive symptoms, while 10.9% exhibited moderate-to-severe symptoms; 6.1% had suicidal ideation. Depression risk factors included school type, residential area, and frequency of parental discipline. Adolescents in public schools had a 5.03 times higher likelihood of depression compared to their private school counterparts (AOR: 5.03; CI: 2.02–12.54), and those frequently disciplined by parents were 3.18 times more likely to experience depression (OR: 3.18; CI: 1.30–7.81). Senior students showed a higher risk of suicidal behavior (OR: 0.15; CI: 0.07–0.34), as did those in public schools (OR: 3.67; CI: 1.70–8.37) and those frequently punished (OR: 6.67; CI: 2.15–20.73). Depression and suicidality were strongly correlated ( p ≤ 0.01). Conclusion: The notable rates of depression and suicidal behavior in Nigerian adolescents underscore the need for targeted mental health interventions. Establishing support structures and policy interventions in schools and communities could help identify and support at-risk adolescents, reducing the risk of adverse mental health outcomes. Psychology Epidemiology Educational Psychology School Counseling Adolescent Depression Nigeria Predictors Secondary schools Suicidal behaviour Figures Figure 1 Figure 2 1. Introduction Globally, mental disorder accounts for 13% of disease burden affecting persons between the age of 10 and 19 years, with one in seven persons exhibiting observable symptoms. Depression, anxiety and behavioural disorders are the commonest forms of mental illness among adolescents, with suicide ranking the fourth leading cause of death among 15-29-year-olds (World Health Organization [WHO], 2021). Depression, a common mental disorder among adolescents worldwide, is defined as a state of low mood and aversion to activity, with an estimated 1-year prevalence in 4–5% mid- to late- adolescents (Costello et al. 2005 ; De Zwart et al. 2019 ). Loss of pleasure/interest in daily life activities, feelings of worthlessness, irritability, loss of appetite, insomnia or hypersomnia, significant weight loss or gain, energy loss and inability to concentrate are the common characteristics features (First et al. 2015 ). Among adolescents, it is usually manifested in the form of emotional 9 accompanied by worthlessness, hopelessness and disrupted thinking (Peterson et al. 1993 ). Depression, if ignored and not treated, can progress, worsen and lead to self-harm with the most severe end-result being suicide (WHO, 2018a). Suicidality is a term frequently used to describe a variety of suicidal behavior including suicidal ideation, plans, threats, attempts, and complete suicide (Nock et al. 2008 ; Marthoenis and Yasir Arafat 2022 ; Tan et. 2015). Suicidal ideation, plans, threats, and attempts considered as non-fatal suicidality, whereas complete suicide considered as fatal suicidality because it results in death (Tan et al. 2015 ). Defined as death by intentional self-directed injury, suicide amid young people (15–29 years) accounts for one-third of all suicides globally and is the second leading cause of death in this age group (WHO, 2018b), with 79% of suicide cases occurring in Low- and Middle-income Countries (LMICs) like Nigeria where resource and personnel are scarce (Adewuya et al. 2020). As found by many studies, depression is closely associated with suicide and suicidal behaviors (Coentre et al. 2016 ; Ibrahim et al. 2017 ; Wang et al. 2017 ; Nguyen Thi Khanh et al. 2020 ) and specifically as a predictor (Meng et al. 2013 ; Nguyen Thi Khanh et al. 2020 ) among young persons. The challenges associated with identifying depression and predicting suicidal ideation among adolescents stems from the lack of awareness and the poor help-seeking behavior prevalent among them (Alinnor and Okeafor 2023 ). However, previous studies conducted in and across LMICs have identified factors like female gender (Bayati et al. 2009 ; McKinnon et al. 2016 ; Nguyen Thi Khanh et al. 2020 ; Kurniawan et al. 2024 ), academic and relationship difficulties (Amarasuriya et al. 2015 ; Kurniawan et al. 2024 ), post-traumatic stress disorder, sleeping problems and family issues (Oladele and Oladele 2016 ; Aboagye et al. 2022 ) and substance abuse (Khan et al. 2006 ; McKinnon et al. 2016 ; Nguyen Thi Khanh et al. 2020 ) respectively, as predictors of depression and suicide among students. This cross-sectional study was conducted to provide a nuanced understanding of the predictors of depression and suicidal behavior among in-school adolescents in Nigeria. Primary data was collected from 621 randomly selected respondents. 2. Materials & Methods 2.1. Study setting and participants This study was a descriptive cross-sectional study. The study population was composed of six hundred and twenty-one (621) students attending secondary schools (both junior and senior) of mixed schools (day and boarding), government-owned public schools, and government-approved private school, from six schools across 3 local government areas of Benin City, Edo State, Nigeria. The data were collected in a 3-months period from March until May 2024. The multi-stage random sampling technique was used to select eligible respondents. 2.2. Procedure 2.2.1 Measures and Instruments The data was collected using a sociodemographic questionnaire, and two standardized and validated self-rated instruments (Patient Health Questionnaire-9 Scale and Suicidal Behaviour Questionnaire-Revised). Socio-demographic Questionnaire The study utilized an adapted version of a 40-items socio-demographic questionnaire from a previous Nigerian study to collect comprehensive information about the participants. The questionnaire included items addressing various aspects such as age, sex, child migration, and family structure (core or extended). Additional questions focused on the number of children in the household, family economic status, and the environment of upbringing (urban or rural). Furthermore, the questionnaire assessed parental education levels, employment status, and the type of guardianship (foster care, single parent, grandparent, or other relatives). Lastly, it gathered information regarding parental marital status (single, married, or divorced). This approach aimed to identify potential risk factors associated with depression and suicidal behavior among adolescents. Patient Health Questionnaire-9 Scale (PHQ-9) To assess depressive symptoms among secondary school students, we employed the 9-Item Patient Health Questionnaire (PHQ-9) (Kroenke et al. 2001 ). This standardized self-report instrument has been extensively validated and is recognized for its effectiveness in screening for depression across various age groups, including adolescents, in both clinical and non-clinical contexts (Anand et al. 2021 ). PHQ-9, a 9-item depression scale, reports depressive symptoms in the last two weeks. Each item is scored from 0 to 3 (0 = not at all, 1 = several days, 2 = more than half the days, three = nearly every day). A total score ranges from 0 to 27. The level of depression is categorized as "0–4 = minimal," "5–9 = mild," "10–14 = moderate," "15–19 = moderately severe," and "20 and above = severe. Further categorization was done during the analysis, and two categories were created using a score of ≤ 9 for the non-depressed group and ≥ 10 for the depressed group (Olawade et al. 2020 ; Olawade et al. 2021 ). Suicidal Behaviour Questionnaire-Revised (SBQ-R) To evaluate suicidality among secondary school students, we utilized the Suicidal Behaviors Questionnaire-Revised (SBQ-R) (Osman et al. 2001). This standardized self-report tool is well-validated and effectively screens for suicidal behaviors across various age groups, including adolescents, in both clinical and non-clinical environments (Osman et al. 2001; Adjorlolo et al. 2022 ). This instrument consists of four items rated using Likert-scale that evaluate lifetime suicidal ideation/suicidal plan/suicide attempt (item-1 with 4 points), the frequency of suicidal ideation over the past 12 months (item-2 with 5 points), the threat of suicide attempt (item-3 with 3 points), and self-reported likelihood of suicidal behaviour in the future (item-4 with 6 points). A total calculated score of > 7(0–6) was considered the cutoff score for students with suicidal behaviour (Poudel et al. 2022 ). 2.2.2. Data Collection Data collection was conducted manually by distributing questionnaires to students in their classrooms. Prior to administering the survey, we provided a thorough explanation of the study's purpose, potential benefits, and risks, as well as the measures in place to ensure confidentiality. Informed consent was obtained from all participants before they engaged in the study. Each questionnaire was completed anonymously, and participation was entirely voluntary. 2.2.3. Statistical Analysis The collected data was entered into Microsoft Excel and its accuracy was checked repeatedly. The Social Science Statistical Software Package (SPSS) version 25.0 (IBM, Chicago, IL, USA) was used to enter, verify, and analyze data. For each variable considered in the analysis, frequency and percentage were calculated. Chi-square analysis and Fisher precision tests were performed to examine sociodemographic associations with depression and suicidal behaviour outcomes. Logistic regression analysis was used to determine the factors that predicted depression and suicidal behaviour, with p < 0.05 indicating statistically significant results. 2.3. Ethical Consideration Approval for the study was obtained from the Department of Maternal and Child Health and accredited by Xiangya School of Public Health, Central South University. The research protocol received ethical clearance from the Institutional Review Board at Central South University. Prior to data collection, all participants were informed about the study and asked for their consent, with the assurance that they could withdraw at any time without facing any repercussions. Additionally, permission was secured from the principals of the participating schools before conducting the survey. Throughout the study, participant confidentiality was upheld by ensuring that all responses were anonymous and used solely for research purposes. 3. Results 3.1. Psycho-social and demographic characteristics of respondents A total of 621 students consented to participate in the study, with the majority being under 18 years of age. Regarding sociodemographic characteristics, 52.7% of respondents were female, 61.0% were in senior secondary school, and 51.7% attended public schools. Most participants reported living with married parents (85.8%) within a monogamous family structure (83.7%), and over half indicated they resided with their parents (58.6%). Additionally, 46.9% of respondents lived in urban areas, 41.9% in semi-urban areas, and 11.3% in rural settings. Concerning psychosocial factors, a significant number of participants reported having experienced physical discipline or scolding by their parents (Table 1 ). Table 1 Psycho-socio and demographic characteristics related behaviour of respondents Variable Total N = 621 Frequency ( n ) Percentage (%) Age group Below 18 18 and above 593 28 95.5 4.5 Gender Male Female 294 327 47.3 52.7 Type of school Public Private 321 300 51.7 48.3 Class of Respondent Junior secondary Senior secondary 379 242 61.0 39.0 Family type Monogamous Polygamous 520 101 83.7 16.3 Marital status of parent Married Divorced/separated Widowed 533 48 40 85.8 7.7 6.4 Who do you live with presently Parent Single parent Grandparent Others 364 90 84 77 58.6 14.5 13.5 13.4 Place of residence Urban Semi Urban Rural 291 260 70 46.9 41.9 11.3 Frequency of beating/scolding by parents Always Sometimes Rarely Never 76 321 134 90 12.2 51.7 21.6 14.5 N = Study population; n = sample population; % = percentage of the sample population 3.2. Types of Depressive Symptoms Majority of the respondents (64.6%) did not report symptom of loss interest or pleasure in activities. Similarly, 69.9% indicated they did not feel depressed or hopeless, and 73.9% did not experience difficulties in falling or staying asleep. More than half (51.7%) did not report issues with poor appetite or overeating. Additionally, 74.2% had trouble concentrating on tasks such as reading the newspaper or watching television, while 81.8% did not contemplate death or self-harm (Table 2 ). Table 2 Symptoms of depression VARIABLES Not at all Several days More than half the days Nearly every day n (%) n (%) n (%) n (%) Little interest or pleasure in doing things 401 (64.6) 103 (16.6) 37 (6.0) 80 (12.9) Feeling down, depressed, or hopeless 434 (69.9) 106 (17.1) 36 (5.8) 45 (7.2) Trouble falling or staying asleep, or sleeping too much 459 (73.9) 93 (15.0) 28 (4.5) 41 (6.6) Feeling tired or having little energy 433 (69.7) 105 (16.9) 32 (5.2) 51 (8.2) Poor appetite or overeating 321 (51.7) 223 (35.9) 25 (4.0) 52 (8.4) Feeling bad about yourself - or that you are a failure or have let yourself or your family down 495 (79.7) 83 (13.4) 21 (3.4) 22 (3.5) Trouble concentrating on things, such as reading the newspaper or watching television 461 (74.2) 101 (16.3) 25 (4.0) 34 (5.5) Moving or speaking so slowly that other people could have noticed? Or the opposite - being so fidgety or restless that you have been moving around a lot more than usual 508 (81.8) 67 (10.8) 16 (2.6) 30 (4.8) Thoughts that you would be better off dead, or of hurting yourself in some way 508 (81.8) 75 (12.1) 29 (4.7) 9 (1.4) n = sample population; % = percentage of the sample population 3.3. Prevalence of Depression and of Suicidality Figure 1 illustrates the trends in depression levels among secondary school students, as assessed by the PHQ-9. The findings revealed that most respondents, 391 (63%), experienced minimal depression. Additionally, 162 students (26.1%) reported mild depression, 55 students (8.9%) had moderate depression, 8 students (1.3%) experienced moderately severe depression, and 5 respondents (0.8%) reported severe depression. The Fig. 2 shows the prevalence trends of suicidal behavior among secondary students as determined by the SBQ-R. Our results shows that the prevalence of 6.1% of suicidal behaviour was recorded among the respondents 3.4. Correlation between socio-demographics and depression Results from bivariate analysis with Chi-square (and Fisher’s Exact tests where required due to small cell sizes) indicate that type of school attended (χ 2 = 34.53, p < 0.001), place of residence (χ 2 = 10.85, p < 0.01), and frequency of being beaten by parent (χ 2 = 22.01, p < 0.001), were significantly associated with depression among the participants (Table 3 ). Table 3 Correlation between Socio-demographics and Depression. Variable Depression X 2 df p -value Minor (%) Major (%) Age group Below 18 18 and above 529(89.2) 24(85.7) 64(10.8) 4(14.3) 0.34 1 0.76* Gender Male Female 264(89.8) 289(88.4) 30(10.2) 38(11.6) 0.32 1 0.57 Type of school Public Private 263(81.9) 290(96.7) 58(18.1) 10(3.3) 34.53 1 < 0.001 Family type Monogamous Polygamous 460(88.5) 93(92.1) 60(11.5) 8(7.9) 1.12 1 0.29 Marital status of parent Married Divorced/separated/Widowed/No parent 472(88.6) 81(92.0) 61(11.4) 7(8.0) 0.94 1 0.33 Who do you live with presently Parent Single parent Grandparent Foster care Others 323(88.7) 82(91.1) 76(90.5) 5(83.3) 67(87.0) 41(11.3) 8(8.9) 8(9.5) 1(16.7) 10(13.0) 1.13 4 0.89 Place of residence Urban Semi Urban Rural 259(89.0) 224(86.2) 70(100.0) 32(11.0) 36(13.8) 0(0.0) 10.85 2 0.004 Frequency of beating/scolding by parents Always Sometimes Rarely Never 58(76.3) 283(88.2) 130(97.0) 82(91.1) 18(23.7) 38(11.8) 4(3.0) 8(8.9) 22.01 3 < 0.001 n = sample population; % = percentage of the sample population; *Fischer’s exact test was used. 3.5. Association between socio-demographics and suicide behaviour Results from bivariate analysis with Chi-square (and Fisher’s Exact tests where required due to small cell sizes) indicate that type of school (χ 2 = 12.04, p = 0.001), class of respondents (χ 2 = 27.20, p < 0.001), and frequency of being beaten by parent (χ 2 = 50.71, p < 0.001), were significantly associated with suicide behaviour among the participants (Table 4 ). Table 4 Association between socio-demographics and suicide behaviour. Variable Suicide Behaviour X 2 df p -value Absent (%) Present (%) Age group Below 18 18 and above 557 (93.9) 26 (92.9) 36 (6.1) 2 (7.1) 0.05 1 1.00 Gender Male Female 289 (95.9) 301(92.0) 12 (4.1) 26 (8.0) 4.04 1 0.05 Type of school Public Private 291(90.7) 292(97.3) 30 (9.3) 8 (2.7) 12.04 1 0.001 Class of respondents Junior secondary Senior secondary 371 (97.9) 212 (87.6) 8 (2.1) 30 (12.4) 27.20 1 < 0.001 Family type Monogamous Polygamous 484(93.1) 99(98.0) 36 (6.9) 2 (2.0) 3.60 1 0.06 Marital status of parent Married Divorced/separated/widowed/No parent 502 (94.2) 81 (92.0) 31(5.8) 7 (8.0) 0.60 1 0.44 Who do you live with presently Parent Single parent Grandparent Foster care Others 346 (95.1) 81 (90.0) 78 (92.9) 6 (100.0) 72 (93.5) 18 (4.9) 9 (10.0) 6 (7.1) 0 (0.0) 5 (6.5) 3.80 4 0.40* Place of residence Urban Semi Urban Rural 272 (93.5) 241(92.7) 70 (100.0) 19(6.5) 19(7.3) 0(0.0) 5.29 2 0.07 Frequency of beating/scolding by parents Always Sometimes Rarely Never 58 (76.3) 305 (95.0) 134 (100.0) 86 (95.6) 18(23.7) 16(5.0) 0(0.0) 4(4.4) 50.71 3 < 0.001 n = sample population; % = percentage of the sample population; *Fischer’s exact test was used. 3.6. Determinants of depression and suicidality As reported from Table 5 , results from Univariate analysis with logistic regression showed that participants in public school were 6.40 times more likely to be depressed compared to those in private school (OR = 6.40, P = <0.001, 95% CI: 3.20─12.77). Respondents who resided in semi-urban areas were 0.77-fold more likely to experience depressive episodes compared to those who live in urban areas (OR = 0.77, P = <0.01, 95% CI: 0.46─1.28). Participants who report that parent always beat them were 3.18 times more likely to suffer major depression compared to those participants who said they were never beaten by parent (OR = 3.18, P = .0.01, 95% CI: 1.30─7.81). Results from univariate analysis with logistic regression showed that participants in public school were 3.76 times more likely to be exhibit suicide behaviours compared to those in private school (OR = 3.76, P = 0.001, 95% CI: 1.70─8.35). Participants who report that parent always beat them were 6.67 times more likely to exhibit suicide behaviour compared to those participants who said they were never beaten by parent (OR = 6.67, P = .0.001, 95% CI: 2.15─20.73). A multivariate analysis showed that participants in Junior class were 0.15 times less likely to exhibit suicide behaviour compared to those in senior class (OR = 0.15, P <0.001, 95% CI: 0.07─0.34). Table 5 Predictors of depression and suicidality among in-school adolescents based on binary logistic regression ( n = 621) Determinant of depression OR p- value 95% CI AOR p- value 95% CI Type of school Public Private 6.40 < 0.001 3.20─12.77 5.03 0.001 2.02─12.54 Place of residence Urban Semi Urban Rural 0.77 1 ― 0.004 ― 0.46─1.28 ― 0.57 1 ― 0.001 ― 0.34─0.94 ― Frequency of beating/scolding by parents Always Sometimes Rarely Never 3.18 1.38 0.32 1 0.01 0.43 0.07 1.30─7.81 0.62─3.07 0.09─1.08 2.10 1.25 0.33 0.15 0.61 0.09 0.77─5.72 0.53─2.97 0.09─1.18 Determinant of Suicide OR p- value 95% CI AOR p- value 95% CI Gender Male Female 0.49 1 0.05 0.24─1.0 0.54 0.17 0.22─1.29 Type of school Public Private 3.76 1 0.001 1.70─8.35 0.78 0.64 0.28─2.17 Class of Respondent Junior Senior 0.15 1 < 0.001 0.07─0.34 0.11 < 0.001 0.04─0.32 Place of residence Urban Semi Urban Rural 0.89 1 ― 0.07 ― 0.46─1.71 ― 0.98 1 ― 0.24 ― 0.42─2.22 ― Frequency of beating/scolding by parents Always Sometimes Rarely Never 6.67 1.13 ― 1 0.001 0.83 2.15─20.73 0.37─3.46 4.72 1.28 0.02 0.71 1.23─18.17 0.35─4.70 OR : odds ratio, AOR : adjusted odds ratio, CI : confidence interval 3.7. Correlation between Suicidal behaviour and Depression As shown in Table 6 , there was a statistically significant correlation between depression and suicide behaviour ( p < 0.001). Table 6 Association between Suicidal behaviour and Depression Suicide behaviour X 2 df p -value Suicidal Non suicidal Depression Non-depressed Depressed 163 (99.4) 19 (61.3) 1 (0.6) 12 (38.7) 60.82 1 < 0.001 *Fischer’s exact test was used. The finding revealed that a substantial majority of respondents reported minimal symptoms of depression. Specifically, 64.6% did not experience a loss of interest or pleasure in daily activities. Additionally, 69.9% did not indicate feeling of depression or hopelessness, while 73.9% reported no difficulties with falling or staying asleep. More than half of the participants (51.7%) did not struggle with issues related to appetite, such as overeating or poor appetite. Furthermore, 74.2% did not encounter challenges with concentration, such as difficulties in reading the newspaper or watching television. Notably, 81.8% of respondents did not consider death or self-harm as preferable options. These results suggest a relatively low prevalence of significant depressive symptoms within this population, indicating potential resilience among the students (Table 2 ). 4. Discussion As found by this study, 63% of in-school adolescents experience minimal depression, 26.1% experience mild depression, 8.9% experience moderate depression, 1.3% experience moderately severe depression and 0.8% experience severe depression. This is similar to findings by Adeniyi et al. ( 2011 ), who reported a 5.7% prevalence of major depressive symptoms and 23.8% of mild-to-moderate symptoms among Nigerian adolescents. On the other hand, presence of suicidal behavior was reported by 6.1% of respondents which exactly tallies with the findings by Adewuya et al. (2021) which found a weighted 1-month prevalence of 6.1% for suicidal ideation, 4.4% for suicidal plan and 2.8% for suicidal attempt within the same Nigerian context. Significantly associated with the prevalence of depression and suicidal behavior was the “type of school attended”, with public school attendees 6.40 times likelier to be depressed and 3.76 times likelier to have suicidal behaviors than private school attendees. Similar studies by Singh et al. ( 2017 ) in India and Rowland et al. ( 2023 ) in Australia also found the school-type is a significant predictor of depression and suicidal symptom among adolescents. In India this disparity was attributed to factors like lower family income and socio-economic standard of public-school attendees as well as the limited school’s support system available to them, as compared to private schools. In Australia, the overt tradition and practice of care, support and associations within the catholic schools as against public and private schools, were posited as supportive factors against depression and suicidal behaviors among in-school adolescents (Rowland et al. 2023 ). The second factor associated with depression and suicidal behaviors as identified by this study was “frequency of beating by parent”. Adolescents who were always beaten by their parents were 3.18 times likelier to experience depression and 6.67 times likelier to exhibit suicidal behaviors, as compared to their counterparts who were seldomly beaten. To illustrate this, a large-scale study of 8,316 adults found that spanking in childhood was associated with moderate to heavy drinking, drug use and suicide attempts in adulthood (Afifi et al. 2017), which is consistent with a similar finding made by Gong et al. ( 2020 ) in China. A meta-analysis on the consequences of corporal punishments in general on children, found its strong association with indicators of poor mental health including depression and suicide (Visser et al. 2022 ; Ferguson 2013 ). Countries that have not enacted national bans on corporal punishment have been reported to experience higher rates of adolescent suicide compared to countries that have fully banned it (Laura et al. 2023). An association was also found between suicidal behavior and the “class/grade of adolescent”, with adolescents in junior classes 0.15 times more likely to exhibit suicide behaviour compared to their counterpart in senior classes. A longitudinal study of African American adolescents by Whipple et al. ( 2023 ) in the US found that 30% of them experienced high suicidal ideation at some points between their 9th and 10th grade. This corroborates a previous study by the Center for Disease Control [CDC] in 2019 which tagged the suicide rate of African American Adolescents as “high risk”, with an alarming 12.9% of 9th grade youth attempting at least one suicide the previous year (CDC 2019). As also observed by reports from the National Substance Abuse and Mental Health Service Administration, 2006), the odds of depression and suicide increases as one progresses through life. Depression has been reported as the most common “symptom” of suicide in adolescents and is highly prevalent among persons with suicidal ideations and attempts (Shaffer et al. 1996 ; Gould 1998), which is consistent with the finding from this study which showed a significant association between depression and suicidal behavior. Alongside other mental health conditions like anxiety and stress, depression has been found to have the most contribution and a major predictor of suicidal behavior among children and adolescents (Gledhill and Hodes 2010 ; Izadinia et al. 2010 ). However, there are empirical evidences that supports that child aversities including low social support, maternal depression, sexual abuse and domestic violence influences are risk factors for both depression and suicidal behaviors during adolescence (Boden et al. 2007 ; Enns et al. 2006 ) Strengths and limitations This study was subjected to several limitations that need to be acknowledged. First, the study used a self-reported survey. This study may have raised the possibility of recall bias and social desirability bias. The data collectors team tried to minimize students’ misunderstanding by explaining the content prior data collection. Mixed-methods research should be conducted in the future to obtain qualitative responses from the participants that could be used as supplementary information. Second, since this was a cross-sectional study, the nature of this research design makes it impossible to show a cause-and-effect association between the variables. The findings of this study support the recommendation for longitudinal research to be conducted in the future to provide better understanding regarding our identified predictors. Apart from these disadvantages, our study has several strengths. Firstly, this current study provides up-to-date evidence on suicidal behavior and depression among adolescents Benin City, Edo state, Nigeria. Secondly, our study recruited students from both private and public high schools. A significant regionally representative non-clinical sample and high participation rate in the survey could be considered as the strengths of primary importance of the current study. It allowed us to obtain a sample size with diverse sociodemographic backgrounds, increasing the generalizability of the study population. Thus, this study provides information that can serve as a building block for further studies. 5. Conclusion Results from this study show that very few in-school adolescents experience moderate and severe forms of depression while majority experience minimal and mild levels. The experience of suicidal behavior was also reported low at 6.1% among in-school adolescents. Two distinctive factors i.e., type of school attended and frequency of beating were found as major predictors of depression and suicidal behavior among in-school adolescents. Another peculiar predictor of suicidal behavior was the class/grade of adolescent. Greater risk was found among adolescents in higher classes than in lower classes. Finally, depression was indicated as the most common symptom/indicator of suicidal behavior among in-school adolescents. This suggests that in reducing the tendencies for suicidal behaviors, risk of depression must be addressed among in-school adolescents. Recommendations In line with study findings, it is recommended that psychosocial support system be institutionalized and strengthened in particularly public schools across Nigeria. This is coupled with the fact that public schools host more pupils and students as against private schools. According to Sasu ( 2022 ) 22.7 million children are hosted in public schools and 5.4 million in private schools. The practice of corporal punishment both in schools and homes should be discouraged through awareness-raising and attitudinal change interventions for parents and teachers. Constructive reward and punishment systems should be identified and adopted for especially adolescents as against physical battery. With depression as a major indicator for suicidal behavior among adolescents, it is recommended that awareness and education programs be designed for students both formally and informally, to equip them with knowledge and skills for prevention, reporting and recovery. A proposed direction for further research is to examine the roles of teachers and parents in addressing depression and suicidal tendencies among adolescents in Nigeria. References Aboagye RG, Ahinkorah BO, Seidu AA, Okyere J, Frimpong JB, Kumar M (2022) In-school adolescents' loneliness, social support, and suicidal ideation in sub-Saharan Africa: Leveraging Global School Health data to advance mental health focus in the region. PLoS ONE 17(11):e0275660. https://doi.org/10.1371/journal.pone.0275660 Adeniyi AF, Okafor NC, Adeniyi CY (2011) Depression and physical activity in a sample of nigerian adolescents: levels, relationships and predictors. 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Asian J Psychiatry 15:32–37. https://doi.org/10.1016/j.ajp.2015.04.012 Anand P, Bhurji N, Williams N, Desai N (2021) Comparison of PHQ-9 and PHQ-2 as Screening Tools for Depression and School Related Stress in Inner City Adolescents. J Prim Care Community Health 12:21501327211053750. https://doi.org/10.1177/21501327211053750 Bayati A, Beigi M, Salehi M (2009) Depression prevalence and related factors in Iranian students. Pak J Biol Sci 12(20):1371–1375. https://doi.org/10.3923/pjbs.2009.1371.1375 Boden JM, Fergusson DM, Horwood LJ (2007) Anxiety disorders and suicidal behaviours in adolescence and young adulthood: findings from a longitudinal study. Psychol Med 37(3):431–440. https://doi.org/10.1017/S0033291706009147 Centers for Disease Control and Prevention (2019) Youth Risk Behavior Surveillance System results Coentre R, Faravelli C, Figueira ML (2016) Assessment of depression and suicidal behaviour among medical students in Portugal. Int J Med Educ 7:354–363. https://doi.org/10.5116/ijme.57f8.c468 Costello EJ, Egger H, Angold A (2005) 10-year research update review: the epidemiology of child and adolescent psychiatric disorders: I. Methods and public health burden. J Am Acad Child Adolesc Psychiatry 44(10):972–986. https://doi.org/10.1097/01.chi.0000172552.41596.6f De Zwart PL, Jeronimus BF, De Jonge P (2019) Empirical evidence for definitions of episode, remission, recovery, relapse and recurrence in depression: a systematic review. Epidemiol Psychiatric Sci 28(5):544–562. https://doi.org/10.1017/S2045796018000227 Enns MW, Cox BJ, Afifi TO, De Graaf R, Ten Have M, Sareen J (2006) Childhood adversities and risk for suicidal ideation and attempts: a longitudinal population-based study. Psychol Med 36(12):1769–1778. https://doi.org/10.1017/S0033291706008646 Ferguson CJ (2013) Spanking, corporal punishment and negative long-term outcomes: a meta-analytic review of longitudinal studies. Clin Psychol Rev 33(1):196–208. https://doi.org/10.1016/j.cpr.2012.11.002 First MB, Williams JB, Karg RS, Spitzer RL (2015) Structured Clinical Interview for DSM-5-Research Version (SCID-5 for DSM-5, research version; SCID-5-RV). The Encyclopedia of Clinical Psychology Arlington, VA: https://doi.org/10.1002/9781118625392 Gledhill J, Hodes M (2010) Depression and Suicidal Behaviour in Children and Adolescents. InnovAiT 3(4):209–213. https://doi.org/10.1093/innovait/inp262 Gong M, Zhang S, Li W, Wang W, Wu R, Guo L, Lu C (2020) Association between Childhood Maltreatment and Suicidal Ideation and Suicide Attempts among Chinese Adolescents: The Moderating Role of Depressive Symptoms. Int J Environ Res Public Health 17(17):6025. https://doi.org/10.3390/ijerph17176025 Gould MS, King R, Greenwald S, Fisher P, Schwab-Stone M, Kramer R, Flisher AJ, Goodman S, Canino G, Shaffer D (1998) Psychopathology associated with suicidal ideation and attempts among children and adolescents. J Am Acad Child Adolesc Psychiatry 37(9):915–923. https://doi.org/10.1097/00004583-199809000-00011 Ibrahim N, Sherina MS, Phang CK, Mukhtar F, Awang H, Ang JK, Zubaidah JO, Ab Ghaffar SF (2017) Prevalence and predictors of depression and suicidal ideation among adolescents attending government secondary schools in Malaysia. Med J Malaysia 72(4):221–227 PMID: 28889133 Izadinia N, Amiri M, Ghorban JR (2010) A study of relationship between suicidal ideas, depression, anxiety, resiliency, daily stresses and mental health among Tehran university students. Procedia-Social Behav Sci 5:1615–1619. https://doi.org/10.1016/j.sbspro.2010.07.335 Khan MS, Mahmood S, Badshah A, Ali SU, Jamal Y (2006) Prevalence of depression, anxiety and their associated factors among medical students in Karachi, Pakistan. J Pak Med Assoc 56(12):583–586 PMID: 17312648 Kroenke K, Spitzer RL, Williams JB (2001) The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med 16(9):606–613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x Kurniawan D, Fitriawan AS, Susanti BAD, Firdaus I, Suparmanto G, Kafil RF, Wulandari AN, Setyaningsih WAW, Puspitarini Z, Wijoyo EB (2024) Predictors of suicidal behaviors among school-going adolescents: a cross-sectional study in Indonesia. Middle East Curr Psychiatry 31:39. https://doi.org/10.1186/s43045-024-00429-2 Cramm L, Elgar FJ, Pickett W (2023) Corporal punishment bans and adolescent suicide rates: An international ecological study. Child Abuse Negl 137:106022. https://doi.org/10.1016/j.chiabu.2023 Marthoenis M, Yasir Arafat SM (2022) Rate and Associated Factors of Suicidal Behavior among Adolescents in Bangladesh and Indonesia: Global School-Based Student Health Survey Data Analysis. Scientifica (Cairo) 2022:8625345. https://doi.org/10.1155/2022/8625345 McKinnon B, Gariépy G, Sentenac M, Elgar FJ (2016) Adolescent suicidal behaviours in 32 low- and middle-income countries. Bull World Health Organ 94(5):340–350. https://doi.org/10.2471/BLT.15.163295 . F Meng H, Li J, Loerbroks A, Wu J, Chen H (2013) Rural/urban background, depression and suicidal ideation in Chinese college students: a cross-sectional study. PLoS ONE 8(8):e71313. https://doi.org/10.1371/journal.pone.0071313 Nguyen Thi Khanh H, Nguyen Thanh L, Pham Quoc T, Pham Viet C, Duong Minh D, Le Thi Kim A (2020) Suicidal behaviors and depression among adolescents in Hanoi, Vietnam: A multilevel analysis of data from the Youth Risk Behavior Survey 2019. Health Psychol Open 11(2):2055102920954711. https://doi.org/10.1177/2055102920954711 Nock MK, Borges G, Bromet EJ, Cha CB, Kessler RC, Lee S (2008) Suicide and suicidal behavior. Epidemiol Rev 30(1):133–154. https://doi.org/10.1093/epirev/mxn002 Oladele AO, Oladele IT (2016) Depression & Suicidal Ideation among College Students with and without Learning Disabilities in Nigeria. EJSBS 16(2):138–153. https://doi.org/10.15405/ejsbs.187 Olawade DB, Wada OZ, Asaolu FT, Odetayo A, Akeju OO, Olorunsogbon OF (2021) COVID-19 and Students’ Mental Wellbeing: A Cross-Sectional Study across Selected Nigerian Universities. JEBES 34(11):176–186. https://doi.org/10.9734/jesbs/2021/v34i1130377 Olawade DB, Olorunfemi OJ, Wada OZ, Afolalu TD, Enahoro MA (2020) Internet Addiction among University Students during Covid-19 Lockdown: Case Study of Institutions in Nigeria. J Educ Hum Develop 9(4):165–173. https://doi.org/10.15640/jehd.v9n4a17 Osman A, Bagge CL, Gutierrez PM, Konick LC, Kopper BA, Barrios FX The Suicidal Behaviors Questionnaire-Revised (SBQ-R): validation with clinical and nonclinical samples (2001). Assessment 8(4):443–454. https://doi.org/10.1177/107319110100800409 Poudel A, Lamichhane A, Magar KR, Khanal GP (2022) Non suicidal self-injury and suicidal behavior among adolescents: co-occurrence and associated risk factors. BMC Psychiatry 22(1):96. https://doi.org/10.1186/s12888-022-03763-z Peterson AC, Compass BE, Brooks-Gunn J, Stemmlier M, Ey S, Grant KE (1993) Depression in Adolescence. Am Psychol 48(2):155–168. https://doi.org/10.1037/0003-066X.48.2.155 Rowland BC, Mohebbi M, Kelly AB, Benstead ML, Herde JA, Clancy EM, Bailey JA, Hallam B, Sharkey P, Horner R, Toumbourou JW (2023) School Influences on Adolescent Depression: A 6-Year Longitudinal Study Amongst Catholic, Government and Independent Schools, in Victoria, Australia. J Relig Health 62(2):1136–1156. https://doi.org/10.1007/s10943-022-01515-7 . Erratum in: J Relig Health 62(2):1157–1158. https://doi.org/10.1007/s10943-022-01551-3 Saluja G, Iachan R, Scheidt PC, Overpeck MD, Sun W, Giedd JN (2004) Prevalence of and risk factors for depressive symptoms among young adolescents. Arch Pediatr Adolesc Med 158(8):760–765. https://doi.org/10.1001/archpedi.158.8.760 Sasu DD (2022) Number of children enrolled in public and private primary schools in Nigeria as of 2017/2018 by gender. Statistica. URL: https://www.statista.com/statistics/1268419/number-of-children-enrolled-in-public-and-private-primary-schools-in-nigeria-by-gender/#:~:text=In%20the%20school%20year%202017,private%20had%20some%205.4%20million Shaffer D, Gould MS, Fisher P, Trautman P, Moreau D, Kleinman M, Flory M (1996) Psychiatric diagnosis in child and adolescent suicide. Arch Gen Psychiatry 53(4):339–348. https://doi.org/10.1001/archpsyc.1996.01830040075012 Singh MM, Gupta M, Grover S (2017) Prevalence & factors associated with depression among school-going adolescents in Chandigarh, north India. Indian J Med Res 146(2):205–215. https://doi.org/10.4103/ijmr.IJMR_1339_15 Tan ST, Sherina MS, Rampal L, Normala I (2015) Prevalence and predictors of suicidality among medical students in a public university. Med J Malaysia 70(1):1–5 Visser LN, van der Put CE, Assink M (2022) The Association between School Corporal Punishment and Child Developmental Outcomes: A Meta-Analytic Review. Child (Basel) 9(3):383. https://doi.org/10.3390/children9030383 Wang YH, Shi ZT, Luo QY (2017) Association of depressive symptoms and suicidal ideation among university students in China: A systematic review and meta-analysis. Med (Baltim) 96(13):e6476. https://doi.org/10.1097/MD.0000000000006476 Whipple CR, Robinson WL, Flack CE, Jason LA, Keenan K (2023) Longitudinal patterns and predictors of suicidal ideation in African American adolescents. Am J Community Psychol 71(3–4):453–464. https://doi.org/10.1002/ajcp.12663 World Health Organization (2021) Mental health of Adolescents. URL: https://www.who.int/news-room/fact-sheets/detail/adolescent-mental-health (Accessed on 26/05/2023) World Health Organization Depression [Internet]. 2018a [cited 2022 May 27]. https://www.who.int/news-room/fact-sheets/detail/depression World Health Organization (2018b) LIVE LIFE: Preventing Suicide. Department of Mental Health and Substance Abuse, World Health Organization, In. Geneva Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5751576","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":396848589,"identity":"8590cd8c-ede6-4a3b-bbd5-d93ee4682296","order_by":0,"name":"Isabella G. IGHAEDE-EDWARDS","email":"","orcid":"","institution":"Department of Maternal and Child Health, Xiangya School of Public Health, Central South University, Changsha, Hunan, P.R. China","correspondingAuthor":false,"prefix":"","firstName":"Isabella","middleName":"G.","lastName":"IGHAEDE-EDWARDS","suffix":""},{"id":396848590,"identity":"03bf0e8f-d5d5-4b97-9603-155e22efadd0","order_by":1,"name":"Idriss François NTSAME ALLOGO","email":"","orcid":"","institution":"Department of Maternal and Child Health, Xiangya School of Public Health, Central South University, Changsha, Hunan, P.R. China","correspondingAuthor":false,"prefix":"","firstName":"Idriss","middleName":"François NTSAME","lastName":"ALLOGO","suffix":""},{"id":396848591,"identity":"1e56156d-37c0-4f55-8c09-23d3c88d97b4","order_by":2,"name":"Xiaoqun LIU","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAzUlEQVRIiWNgGAWjYBACPmYYi7354IMPBjZ2BLWwwbXwHEs2nFGQlkxYC5wlkWMmzfPhEGMDQS3sPGYSb2rqEhuAthjbGBxgZmA/fHQDfofxGBvOOXY4sQHol8c5Bnf4GHjS0m4Q0GL4mLfhAMSWHINnzAwSPGaEtBgc5m0AOgzkFwuDw4wNRGgB2cIM0cJAnBa2YpBfjNtAgdxjkJbMRsgv/PyHt4FCTLYfFJU//tjY8bMfPoZXCxjwMCBFEBsehahaRsEoGAWjYBTgBACK7ULxHNKVXgAAAABJRU5ErkJggg==","orcid":"","institution":"Department of Maternal and Child Health, Xiangya School of Public Health, Central South University, Changsha, Hunan, P.R. China","correspondingAuthor":true,"prefix":"","firstName":"Xiaoqun","middleName":"","lastName":"LIU","suffix":""},{"id":396848592,"identity":"40183840-2d78-4ddd-9d39-461dc27b981f","order_by":3,"name":"Guy Armel BOUNDA","email":"","orcid":"https://orcid.org/0000-0002-9237-0484","institution":"Department of Clinical Pharmacy, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, Jiangsu, P.R. China","correspondingAuthor":false,"prefix":"","firstName":"Guy","middleName":"Armel","lastName":"BOUNDA","suffix":""},{"id":396848593,"identity":"d5a78a72-5734-47a0-8d1b-be4ff9f9a8e5","order_by":4,"name":"Aanuoluwapo CLEMENT DAVID-OLAWADE","email":"","orcid":"","institution":"4 Endoscopy Unit, Glenfield Hospital, University Hospitals of Leicester, NHS Trust, Leicester, United Kingdom","correspondingAuthor":false,"prefix":"","firstName":"Aanuoluwapo","middleName":"CLEMENT","lastName":"DAVID-OLAWADE","suffix":""},{"id":396848594,"identity":"79bdf543-4221-48f9-8b43-c1ec16c81f86","order_by":5,"name":"David B. OLAWADE","email":"","orcid":"","institution":"Department of Allied and Public Health, School of Health, Sport and Bioscience, University of East London, London, United Kingdom","correspondingAuthor":false,"prefix":"","firstName":"David","middleName":"B.","lastName":"OLAWADE","suffix":""}],"badges":[],"createdAt":"2025-01-02 11:59:28","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-5751576/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5751576/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":73084639,"identity":"07f4d383-489f-4e88-87bb-bd1d091cc538","added_by":"auto","created_at":"2025-01-06 14:40:52","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":36257,"visible":true,"origin":"","legend":"\u003cp\u003eLevel of depression\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5751576/v1/bfe589030a215a4951aca4b2.png"},{"id":73082897,"identity":"d1e44bff-46df-4f93-ae33-07af0f199fa3","added_by":"auto","created_at":"2025-01-06 14:32:52","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":16945,"visible":true,"origin":"","legend":"\u003cp\u003eSuicidal behavior\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-5751576/v1/6527b09b98878138ebd3793b.png"},{"id":73085129,"identity":"3e5b00b7-5cc6-4acc-8e16-17b464ae6b2c","added_by":"auto","created_at":"2025-01-06 14:48:57","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1304685,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5751576/v1/41ce9a2b-c78f-4cec-a269-e601e3e130ae.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003ePredictors of depression and suicidal behaviors among in-school adolescents in Nigeria: A Cross-sectional Study\u003c/p\u003e","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eGlobally, mental disorder accounts for 13% of disease burden affecting persons between the age of 10 and 19 years, with one in seven persons exhibiting observable symptoms. Depression, anxiety and behavioural disorders are the commonest forms of mental illness among adolescents, with suicide ranking the fourth leading cause of death among 15-29-year-olds (World Health Organization [WHO], 2021). Depression, a common mental disorder among adolescents worldwide, is defined as a state of low mood and aversion to activity, with an estimated 1-year prevalence in 4\u0026ndash;5% mid- to late- adolescents (Costello et al. \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2005\u003c/span\u003e; De Zwart et al. \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Loss of pleasure/interest in daily life activities, feelings of worthlessness, irritability, loss of appetite, insomnia or hypersomnia, significant weight loss or gain, energy loss and inability to concentrate are the common characteristics features (First et al. \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). Among adolescents, it is usually manifested in the form of emotional 9 accompanied by worthlessness, hopelessness and disrupted thinking (Peterson et al. \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e1993\u003c/span\u003e). Depression, if ignored and not treated, can progress, worsen and lead to self-harm with the most severe end-result being suicide (WHO, 2018a).\u003c/p\u003e \u003cp\u003eSuicidality is a term frequently used to describe a variety of suicidal behavior including suicidal ideation, plans, threats, attempts, and complete suicide (Nock et al. \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2008\u003c/span\u003e; Marthoenis and Yasir Arafat \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Tan et. 2015). Suicidal ideation, plans, threats, and attempts considered as non-fatal suicidality, whereas complete suicide considered as fatal suicidality because it results in death (Tan et al. \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). Defined as death by intentional self-directed injury, suicide amid young people (15\u0026ndash;29 years) accounts for one-third of all suicides globally and is the second leading cause of death in this age group (WHO, 2018b), with 79% of suicide cases occurring in Low- and Middle-income Countries (LMICs) like Nigeria where resource and personnel are scarce (Adewuya et al. 2020).\u003c/p\u003e \u003cp\u003eAs found by many studies, depression is closely associated with suicide and suicidal behaviors (Coentre et al. \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Ibrahim et al. \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Wang et al. \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Nguyen Thi Khanh et al. \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) and specifically as a predictor (Meng et al. \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2013\u003c/span\u003e; Nguyen Thi Khanh et al. \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) among young persons. The challenges associated with identifying depression and predicting suicidal ideation among adolescents stems from the lack of awareness and the poor help-seeking behavior prevalent among them (Alinnor and Okeafor \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). However, previous studies conducted in and across LMICs have identified factors like female gender (Bayati et al. \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2009\u003c/span\u003e; McKinnon et al. \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Nguyen Thi Khanh et al. \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Kurniawan et al. \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2024\u003c/span\u003e), academic and relationship difficulties (Amarasuriya et al. \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Kurniawan et al. \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2024\u003c/span\u003e), post-traumatic stress disorder, sleeping problems and family issues (Oladele and Oladele \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Aboagye et al. \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) and substance abuse (Khan et al. \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2006\u003c/span\u003e; McKinnon et al. \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Nguyen Thi Khanh et al. \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) respectively, as predictors of depression and suicide among students.\u003c/p\u003e \u003cp\u003eThis cross-sectional study was conducted to provide a nuanced understanding of the predictors of depression and suicidal behavior among in-school adolescents in Nigeria. Primary data was collected from 621 randomly selected respondents.\u003c/p\u003e"},{"header":"2. Materials \u0026 Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1. Study setting and participants\u003c/h2\u003e \u003cp\u003eThis study was a descriptive cross-sectional study. The study population was composed of six hundred and twenty-one (621) students attending secondary schools (both junior and senior) of mixed schools (day and boarding), government-owned public schools, and government-approved private school, from six schools across 3 local government areas of Benin City, Edo State, Nigeria. The data were collected in a 3-months period from March until May 2024. The multi-stage random sampling technique was used to select eligible respondents.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2. Procedure\u003c/h2\u003e \u003cdiv id=\"Sec5\" class=\"Section3\"\u003e \u003ch2\u003e2.2.1 Measures and Instruments\u003c/h2\u003e \u003cp\u003eThe data was collected using a sociodemographic questionnaire, and two standardized and validated self-rated instruments (Patient Health Questionnaire-9 Scale and Suicidal Behaviour Questionnaire-Revised).\u003c/p\u003e \u003cp\u003e \u003cem\u003eSocio-demographic Questionnaire\u003c/em\u003e \u003c/p\u003e \u003cp\u003eThe study utilized an adapted version of a 40-items socio-demographic questionnaire from a previous Nigerian study to collect comprehensive information about the participants. The questionnaire included items addressing various aspects such as age, sex, child migration, and family structure (core or extended). Additional questions focused on the number of children in the household, family economic status, and the environment of upbringing (urban or rural). Furthermore, the questionnaire assessed parental education levels, employment status, and the type of guardianship (foster care, single parent, grandparent, or other relatives). Lastly, it gathered information regarding parental marital status (single, married, or divorced).\u003c/p\u003e \u003cp\u003eThis approach aimed to identify potential risk factors associated with depression and suicidal behavior among adolescents.\u003c/p\u003e \u003cp\u003e \u003cem\u003ePatient Health Questionnaire-9 Scale (PHQ-9)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eTo assess depressive symptoms among secondary school students, we employed the 9-Item Patient Health Questionnaire (PHQ-9) (Kroenke et al. \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2001\u003c/span\u003e). This standardized self-report instrument has been extensively validated and is recognized for its effectiveness in screening for depression across various age groups, including adolescents, in both clinical and non-clinical contexts (Anand et al. \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). PHQ-9, a 9-item depression scale, reports depressive symptoms in the last two weeks. Each item is scored from 0 to 3 (0\u0026thinsp;=\u0026thinsp;not at all, 1\u0026thinsp;=\u0026thinsp;several days, 2\u0026thinsp;=\u0026thinsp;more than half the days, three\u0026thinsp;=\u0026thinsp;nearly every day). A total score ranges from 0 to 27. The level of depression is categorized as \"0\u0026ndash;4\u0026thinsp;=\u0026thinsp;minimal,\" \"5\u0026ndash;9\u0026thinsp;=\u0026thinsp;mild,\" \"10\u0026ndash;14\u0026thinsp;=\u0026thinsp;moderate,\" \"15\u0026ndash;19\u0026thinsp;=\u0026thinsp;moderately severe,\" and \"20 and above =\u0026thinsp;severe. Further categorization was done during the analysis, and two categories were created using a score of \u0026le;\u0026thinsp;9 for the non-depressed group and \u0026ge;\u0026thinsp;10 for the depressed group (Olawade et al. \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Olawade et al. \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cem\u003eSuicidal Behaviour Questionnaire-Revised (SBQ-R)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eTo evaluate suicidality among secondary school students, we utilized the Suicidal Behaviors Questionnaire-Revised (SBQ-R) (Osman et al. 2001). This standardized self-report tool is well-validated and effectively screens for suicidal behaviors across various age groups, including adolescents, in both clinical and non-clinical environments (Osman et al. 2001; Adjorlolo et al. \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). This instrument consists of four items rated using Likert-scale that evaluate lifetime suicidal ideation/suicidal plan/suicide attempt (item-1 with 4 points), the frequency of suicidal ideation over the past 12 months (item-2 with 5 points), the threat of suicide attempt (item-3 with 3 points), and self-reported likelihood of suicidal behaviour in the future (item-4 with 6 points). A total calculated score of \u0026gt;\u0026thinsp;7(0\u0026ndash;6) was considered the cutoff score for students with suicidal behaviour (Poudel et al. \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e \u003ch2\u003e2.2.2. Data Collection\u003c/h2\u003e \u003cp\u003eData collection was conducted manually by distributing questionnaires to students in their classrooms. Prior to administering the survey, we provided a thorough explanation of the study's purpose, potential benefits, and risks, as well as the measures in place to ensure confidentiality. Informed consent was obtained from all participants before they engaged in the study. Each questionnaire was completed anonymously, and participation was entirely voluntary.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section3\"\u003e \u003ch2\u003e2.2.3. Statistical Analysis\u003c/h2\u003e \u003cp\u003eThe collected data was entered into Microsoft Excel and its accuracy was checked repeatedly. The Social Science Statistical Software Package (SPSS) version 25.0 (IBM, Chicago, IL, USA) was used to enter, verify, and analyze data. For each variable considered in the analysis, frequency and percentage were calculated. Chi-square analysis and Fisher precision tests were performed to examine sociodemographic associations with depression and suicidal behaviour outcomes. Logistic regression analysis was used to determine the factors that predicted depression and suicidal behaviour, with \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 indicating statistically significant results.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e2.3. Ethical Consideration\u003c/h2\u003e \u003cp\u003e Approval for the study was obtained from the Department of Maternal and Child Health and accredited by Xiangya School of Public Health, Central South University. The research protocol received ethical clearance from the Institutional Review Board at Central South University. Prior to data collection, all participants were informed about the study and asked for their consent, with the assurance that they could withdraw at any time without facing any repercussions. Additionally, permission was secured from the principals of the participating schools before conducting the survey. Throughout the study, participant confidentiality was upheld by ensuring that all responses were anonymous and used solely for research purposes.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\n \u003ch2\u003e3.1. Psycho-social and demographic characteristics of respondents\u003c/h2\u003e\n \u003cp\u003eA total of 621 students consented to participate in the study, with the majority being under 18 years of age. Regarding sociodemographic characteristics, 52.7% of respondents were female, 61.0% were in senior secondary school, and 51.7% attended public schools. Most participants reported living with married parents (85.8%) within a monogamous family structure (83.7%), and over half indicated they resided with their parents (58.6%). Additionally, 46.9% of respondents lived in urban areas, 41.9% in semi-urban areas, and 11.3% in rural settings. Concerning psychosocial factors, a significant number of participants reported having experienced physical discipline or scolding by their parents (Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003ePsycho-socio and demographic characteristics related behaviour of respondents\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eTotal N\u0026thinsp;=\u0026thinsp;621\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eFrequency (\u003cem\u003en\u003c/em\u003e)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePercentage\u003c/p\u003e\n \u003cp\u003e(%)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAge group\u003c/p\u003e\n \u003cp\u003eBelow 18\u003c/p\u003e\n \u003cp\u003e18 and above\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e593\u003c/p\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e95.5\u003c/p\u003e\n \u003cp\u003e4.5\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e294\u003c/p\u003e\n \u003cp\u003e327\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e47.3\u003c/p\u003e\n \u003cp\u003e52.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eType of school\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003ePublic\u003c/p\u003e\n \u003cp\u003ePrivate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e321\u003c/p\u003e\n \u003cp\u003e300\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e51.7\u003c/p\u003e\n \u003cp\u003e48.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eClass of Respondent\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eJunior secondary\u003c/p\u003e\n \u003cp\u003eSenior secondary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e379\u003c/p\u003e\n \u003cp\u003e242\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e61.0\u003c/p\u003e\n \u003cp\u003e39.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eFamily type\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eMonogamous\u003c/p\u003e\n \u003cp\u003ePolygamous\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e520\u003c/p\u003e\n \u003cp\u003e101\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e83.7\u003c/p\u003e\n \u003cp\u003e16.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital status of parent\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003cp\u003eDivorced/separated\u003c/p\u003e\n \u003cp\u003eWidowed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e533\u003c/p\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e85.8\u003c/p\u003e\n \u003cp\u003e7.7\u003c/p\u003e\n \u003cp\u003e6.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eWho do you live with presently\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eParent\u003c/p\u003e\n \u003cp\u003eSingle parent\u003c/p\u003e\n \u003cp\u003eGrandparent\u003c/p\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e364\u003c/p\u003e\n \u003cp\u003e90\u003c/p\u003e\n \u003cp\u003e84\u003c/p\u003e\n \u003cp\u003e77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e58.6\u003c/p\u003e\n \u003cp\u003e14.5\u003c/p\u003e\n \u003cp\u003e13.5\u003c/p\u003e\n \u003cp\u003e13.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ePlace of residence\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eUrban\u003c/p\u003e\n \u003cp\u003eSemi Urban\u003c/p\u003e\n \u003cp\u003eRural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e291\u003c/p\u003e\n \u003cp\u003e260\u003c/p\u003e\n \u003cp\u003e70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e46.9\u003c/p\u003e\n \u003cp\u003e41.9\u003c/p\u003e\n \u003cp\u003e11.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency of beating/scolding by parents\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eAlways\u003c/p\u003e\n \u003cp\u003eSometimes\u003c/p\u003e\n \u003cp\u003eRarely\u003c/p\u003e\n \u003cp\u003eNever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e76\u003c/p\u003e\n \u003cp\u003e321\u003c/p\u003e\n \u003cp\u003e134\u003c/p\u003e\n \u003cp\u003e90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e12.2\u003c/p\u003e\n \u003cp\u003e51.7\u003c/p\u003e\n \u003cp\u003e21.6\u003c/p\u003e\n \u003cp\u003e14.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" align=\"left\"\u003e\n \u003cp\u003eN\u0026thinsp;=\u0026thinsp;Study population; n\u0026thinsp;=\u0026thinsp;sample population; % = percentage of the sample population\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n \u003ch2\u003e3.2. Types of Depressive Symptoms\u003c/h2\u003e\n \u003cp\u003eMajority of the respondents (64.6%) did not report symptom of loss interest or pleasure in activities. Similarly, 69.9% indicated they did not feel depressed or hopeless, and 73.9% did not experience difficulties in falling or staying asleep. More than half (51.7%) did not report issues with poor appetite or overeating. Additionally, 74.2% had trouble concentrating on tasks such as reading the newspaper or watching television, while 81.8% did not contemplate death or self-harm (Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eSymptoms of depression\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eVARIABLES\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNot at all\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSeveral days\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMore than half the days\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNearly every day\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003en\u003c/em\u003e (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003en\u003c/em\u003e (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003en\u003c/em\u003e (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003en\u003c/em\u003e (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLittle interest or pleasure in doing things\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e401 (64.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e103 (16.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e37 (6.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e80 (12.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFeeling down, depressed, or hopeless\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e434 (69.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e106 (17.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e36 (5.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e45 (7.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTrouble falling or staying asleep, or sleeping too much\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e459 (73.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e93 (15.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28 (4.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e41 (6.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFeeling tired or having little energy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e433 (69.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e105 (16.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32 (5.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e51 (8.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePoor appetite or overeating\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e321 (51.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e223 (35.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25 (4.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e52 (8.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFeeling bad about yourself - or that you are a failure or have let yourself or your family down\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e495 (79.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e83 (13.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21 (3.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22 (3.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTrouble concentrating on things, such as reading the newspaper or watching television\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e461 (74.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e101 (16.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25 (4.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e34 (5.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMoving or speaking so slowly that other people could have noticed?\u003c/p\u003e\n \u003cp\u003eOr the opposite - being so fidgety or restless that you have been moving around a lot more than usual\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e508 (81.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e67 (10.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16 (2.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30 (4.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eThoughts that you would be better off dead, or of hurting yourself in some way\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e508 (81.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e75 (12.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e29 (4.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9 (1.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" align=\"left\"\u003e\n \u003cp\u003en\u0026thinsp;=\u0026thinsp;sample population; % = percentage of the sample population\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\n \u003ch2\u003e3.3. Prevalence of Depression and of Suicidality\u003c/h2\u003e\n \u003cp\u003eFigure \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e illustrates the trends in depression levels among secondary school students, as assessed by the PHQ-9. The findings revealed that most respondents, 391 (63%), experienced minimal depression. Additionally, 162 students (26.1%) reported mild depression, 55 students (8.9%) had moderate depression, 8 students (1.3%) experienced moderately severe depression, and 5 respondents (0.8%) reported severe depression.\u003c/p\u003e\n \u003cp\u003eThe Fig. \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e shows the prevalence trends of suicidal behavior among secondary students as determined by the SBQ-R. Our results shows that the prevalence of 6.1% of suicidal behaviour was recorded among the respondents\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\n \u003ch2\u003e3.4. Correlation between socio-demographics and depression\u003c/h2\u003e\n \u003cp\u003eResults from bivariate analysis with Chi-square (and Fisher\u0026rsquo;s Exact tests where required due to small cell sizes) indicate that type of school attended (\u0026chi;\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;34.53, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), place of residence (\u0026chi;\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;10.85, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01), and frequency of being beaten by parent (\u0026chi;\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;22.01, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), were significantly associated with depression among the participants (Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eCorrelation between Socio-demographics and Depression.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eDepression\u003c/p\u003e\n \u003c/th\u003e\n \u003cth rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eX\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003edf\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMinor (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMajor (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eAge group\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003eBelow 18\u003c/p\u003e\n \u003cp\u003e18 and above\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e529(89.2)\u003c/p\u003e\n \u003cp\u003e24(85.7)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e64(10.8)\u003c/p\u003e\n \u003cp\u003e4(14.3)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.34\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.76*\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e264(89.8)\u003c/p\u003e\n \u003cp\u003e289(88.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e30(10.2)\u003c/p\u003e\n \u003cp\u003e38(11.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.57\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eType of school\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003ePublic\u003c/p\u003e\n \u003cp\u003ePrivate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e263(81.9)\u003c/p\u003e\n \u003cp\u003e290(96.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e58(18.1)\u003c/p\u003e\n \u003cp\u003e10(3.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e34.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eFamily type\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eMonogamous\u003c/p\u003e\n \u003cp\u003ePolygamous\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e460(88.5)\u003c/p\u003e\n \u003cp\u003e93(92.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e60(11.5)\u003c/p\u003e\n \u003cp\u003e8(7.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.29\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital status of parent\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003cp\u003eDivorced/separated/Widowed/No parent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e472(88.6)\u003c/p\u003e\n \u003cp\u003e81(92.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e61(11.4)\u003c/p\u003e\n \u003cp\u003e7(8.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.33\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eWho do you live with presently\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eParent\u003c/p\u003e\n \u003cp\u003eSingle parent\u003c/p\u003e\n \u003cp\u003eGrandparent\u003c/p\u003e\n \u003cp\u003eFoster care\u003c/p\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e323(88.7)\u003c/p\u003e\n \u003cp\u003e82(91.1)\u003c/p\u003e\n \u003cp\u003e76(90.5)\u003c/p\u003e\n \u003cp\u003e5(83.3)\u003c/p\u003e\n \u003cp\u003e67(87.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e41(11.3)\u003c/p\u003e\n \u003cp\u003e8(8.9)\u003c/p\u003e\n \u003cp\u003e8(9.5)\u003c/p\u003e\n \u003cp\u003e1(16.7)\u003c/p\u003e\n \u003cp\u003e10(13.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.89\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ePlace of residence\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eUrban\u003c/p\u003e\n \u003cp\u003eSemi Urban\u003c/p\u003e\n \u003cp\u003eRural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e259(89.0)\u003c/p\u003e\n \u003cp\u003e224(86.2)\u003c/p\u003e\n \u003cp\u003e70(100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e32(11.0)\u003c/p\u003e\n \u003cp\u003e36(13.8)\u003c/p\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e10.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency of beating/scolding by parents\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eAlways\u003c/p\u003e\n \u003cp\u003eSometimes\u003c/p\u003e\n \u003cp\u003eRarely\u003c/p\u003e\n \u003cp\u003eNever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e58(76.3)\u003c/p\u003e\n \u003cp\u003e283(88.2)\u003c/p\u003e\n \u003cp\u003e130(97.0)\u003c/p\u003e\n \u003cp\u003e82(91.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e18(23.7)\u003c/p\u003e\n \u003cp\u003e38(11.8)\u003c/p\u003e\n \u003cp\u003e4(3.0)\u003c/p\u003e\n \u003cp\u003e8(8.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e22.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" align=\"left\"\u003e\n \u003cp\u003en\u0026thinsp;=\u0026thinsp;sample population; % = percentage of the sample population; \u003cem\u003e*Fischer\u0026rsquo;s exact test was used.\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\n \u003ch2\u003e3.5. Association between socio-demographics and suicide behaviour\u003c/h2\u003e\n \u003cp\u003eResults from bivariate analysis with Chi-square (and Fisher\u0026rsquo;s Exact tests where required due to small cell sizes) indicate that type of school (\u0026chi;\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;12.04, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001), class of respondents (\u0026chi;\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;27.20, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and frequency of being beaten by parent (\u0026chi;\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;50.71, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), were significantly associated with suicide behaviour among the participants (Table \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eAssociation between socio-demographics and suicide behaviour.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eSuicide Behaviour\u003c/p\u003e\n \u003c/th\u003e\n \u003cth rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eX\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003edf\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAbsent (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePresent (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eAge group\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003eBelow 18\u003c/p\u003e\n \u003cp\u003e18 and above\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e557 (93.9)\u003c/p\u003e\n \u003cp\u003e26 (92.9)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e36 (6.1)\u003c/p\u003e\n \u003cp\u003e2 (7.1)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.05\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e289 (95.9)\u003c/p\u003e\n \u003cp\u003e301(92.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e12 (4.1)\u003c/p\u003e\n \u003cp\u003e26 (8.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e4.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eType of school\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003ePublic\u003c/p\u003e\n \u003cp\u003ePrivate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e291(90.7)\u003c/p\u003e\n \u003cp\u003e292(97.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e30 (9.3)\u003c/p\u003e\n \u003cp\u003e8 (2.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e12.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eClass of respondents\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eJunior secondary\u003c/p\u003e\n \u003cp\u003eSenior secondary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e371 (97.9)\u003c/p\u003e\n \u003cp\u003e212 (87.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e8 (2.1)\u003c/p\u003e\n \u003cp\u003e30 (12.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e27.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eFamily type\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eMonogamous\u003c/p\u003e\n \u003cp\u003ePolygamous\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e484(93.1)\u003c/p\u003e\n \u003cp\u003e99(98.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e36 (6.9)\u003c/p\u003e\n \u003cp\u003e2 (2.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e3.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital status of parent\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003cp\u003eDivorced/separated/widowed/No parent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e502 (94.2)\u003c/p\u003e\n \u003cp\u003e81 (92.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e31(5.8)\u003c/p\u003e\n \u003cp\u003e7 (8.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.44\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eWho do you live with presently\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eParent\u003c/p\u003e\n \u003cp\u003eSingle parent\u003c/p\u003e\n \u003cp\u003eGrandparent\u003c/p\u003e\n \u003cp\u003eFoster care\u003c/p\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e346 (95.1)\u003c/p\u003e\n \u003cp\u003e81 (90.0)\u003c/p\u003e\n \u003cp\u003e78 (92.9)\u003c/p\u003e\n \u003cp\u003e6 (100.0)\u003c/p\u003e\n \u003cp\u003e72 (93.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e18 (4.9)\u003c/p\u003e\n \u003cp\u003e9 (10.0)\u003c/p\u003e\n \u003cp\u003e6 (7.1)\u003c/p\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003cp\u003e5 (6.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e3.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.40*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ePlace of residence\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eUrban\u003c/p\u003e\n \u003cp\u003eSemi Urban\u003c/p\u003e\n \u003cp\u003eRural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e272 (93.5)\u003c/p\u003e\n \u003cp\u003e241(92.7)\u003c/p\u003e\n \u003cp\u003e70 (100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e19(6.5)\u003c/p\u003e\n \u003cp\u003e19(7.3)\u003c/p\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e5.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency of beating/scolding by parents\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eAlways\u003c/p\u003e\n \u003cp\u003eSometimes\u003c/p\u003e\n \u003cp\u003eRarely\u003c/p\u003e\n \u003cp\u003eNever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e58 (76.3)\u003c/p\u003e\n \u003cp\u003e305 (95.0)\u003c/p\u003e\n \u003cp\u003e134 (100.0)\u003c/p\u003e\n \u003cp\u003e86 (95.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e18(23.7)\u003c/p\u003e\n \u003cp\u003e16(5.0)\u003c/p\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003cp\u003e4(4.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e50.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" align=\"left\"\u003e\n \u003cp\u003en\u0026thinsp;=\u0026thinsp;sample population; % = percentage of the sample population; \u003cem\u003e*Fischer\u0026rsquo;s exact test was used.\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\n \u003ch2\u003e3.6. Determinants of depression and suicidality\u003c/h2\u003e\n \u003cp\u003eAs reported from Table \u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e, results from Univariate analysis with logistic regression showed that participants in public school were 6.40 times more likely to be depressed compared to those in private school (OR = 6.40, \u003cem\u003eP\u003c/em\u003e = \u0026lt;0.001, 95% CI: 3.20─12.77). Respondents who resided in semi-urban areas were 0.77-fold more likely to experience depressive episodes compared to those who live in urban areas (OR = 0.77, \u003cem\u003eP\u003c/em\u003e = \u0026lt;0.01, 95% CI: 0.46─1.28). Participants who report that parent always beat them were 3.18 times more likely to suffer major depression compared to those participants who said they were never beaten by parent (OR = 3.18, \u003cem\u003eP\u003c/em\u003e = .0.01, 95% CI: 1.30─7.81).\u003c/p\u003e\n \u003cp\u003eResults from univariate analysis with logistic regression showed that participants in public school were 3.76 times more likely to be exhibit suicide behaviours compared to those in private school (OR = 3.76, \u003cem\u003eP\u003c/em\u003e = 0.001, 95% CI: 1.70─8.35). Participants who report that parent always beat them were 6.67 times more likely to exhibit suicide behaviour compared to those participants who said they were never beaten by parent (OR = 6.67, \u003cem\u003eP\u003c/em\u003e = .0.001, 95% CI: 2.15─20.73). A multivariate analysis showed that participants in Junior class were 0.15 times less likely to exhibit suicide behaviour compared to those in senior class (OR = 0.15, \u003cem\u003eP\u003c/em\u003e \u0026lt;0.001, 95% CI: 0.07─0.34).\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003ctable id=\"Tab5\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003ePredictors of depression and suicidality among in-school adolescents based on binary logistic regression (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;621)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth colspan=\"7\" align=\"left\"\u003e\n \u003cp\u003eDeterminant of depression\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eOR\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003ep-\u003c/em\u003evalue\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e95% CI\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAOR\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003ep-\u003c/em\u003evalue\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e95% CI\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eType of school\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003ePublic\u003c/p\u003e\n \u003cp\u003ePrivate\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e6.40\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e3.20─12.77\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e5.03\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e2.02─12.54\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ePlace of residence\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eUrban\u003c/p\u003e\n \u003cp\u003eSemi Urban\u003c/p\u003e\n \u003cp\u003eRural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.77\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003cp\u003e―\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003cp\u003e―\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.46─1.28\u003c/p\u003e\n \u003cp\u003e―\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.57\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003cp\u003e―\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003cp\u003e―\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.34─0.94\u003c/p\u003e\n \u003cp\u003e―\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency of beating/scolding by\u003c/strong\u003e \u003cem\u003eparents\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003eAlways\u003c/p\u003e\n \u003cp\u003eSometimes\u003c/p\u003e\n \u003cp\u003eRarely\u003c/p\u003e\n \u003cp\u003eNever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e3.18\u003c/p\u003e\n \u003cp\u003e1.38\u003c/p\u003e\n \u003cp\u003e0.32\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003cp\u003e0.43\u003c/p\u003e\n \u003cp\u003e0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.30─7.81\u003c/p\u003e\n \u003cp\u003e0.62─3.07\u003c/p\u003e\n \u003cp\u003e0.09─1.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2.10\u003c/p\u003e\n \u003cp\u003e1.25\u003c/p\u003e\n \u003cp\u003e0.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.15\u003c/p\u003e\n \u003cp\u003e0.61\u003c/p\u003e\n \u003cp\u003e0.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.77─5.72\u003c/p\u003e\n \u003cp\u003e0.53─2.97\u003c/p\u003e\n \u003cp\u003e0.09─1.18\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eDeterminant of Suicide\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eOR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-\u003c/strong\u003e\u003cstrong\u003evalue\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAOR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-\u003c/strong\u003e\u003cstrong\u003evalue\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.49\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.24─1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.22─1.29\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eType of school\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003ePublic\u003c/p\u003e\n \u003cp\u003ePrivate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e3.76\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.70─8.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.28─2.17\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eClass of Respondent\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eJunior\u003c/p\u003e\n \u003cp\u003eSenior\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.15\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.07─0.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.04─0.32\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ePlace of residence\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eUrban\u003c/p\u003e\n \u003cp\u003eSemi Urban\u003c/p\u003e\n \u003cp\u003eRural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.89\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003cp\u003e―\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.07\u003c/p\u003e\n \u003cp\u003e―\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.46─1.71\u003c/p\u003e\n \u003cp\u003e―\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.98\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003cp\u003e―\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.24\u003c/p\u003e\n \u003cp\u003e―\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.42─2.22\u003c/p\u003e\n \u003cp\u003e―\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency of beating/scolding by\u003c/strong\u003e \u003cem\u003eparents\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003eAlways\u003c/p\u003e\n \u003cp\u003eSometimes\u003c/p\u003e\n \u003cp\u003eRarely\u003c/p\u003e\n \u003cp\u003eNever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e6.67\u003c/p\u003e\n \u003cp\u003e1.13\u003c/p\u003e\n \u003cp\u003e―\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003cp\u003e0.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2.15─20.73\u003c/p\u003e\n \u003cp\u003e0.37─3.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e4.72\u003c/p\u003e\n \u003cp\u003e1.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003cp\u003e0.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.23─18.17\u003c/p\u003e\n \u003cp\u003e0.35─4.70\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eOR\u003c/em\u003e: odds ratio, \u003cem\u003eAOR\u003c/em\u003e: adjusted odds ratio, \u003cem\u003eCI\u003c/em\u003e: confidence interval\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\n \u003ch2\u003e3.7. Correlation between Suicidal behaviour and Depression\u003c/h2\u003e\n \u003cp\u003eAs shown in Table \u003cspan class=\"InternalRef\"\u003e6\u003c/span\u003e, there was a statistically significant correlation between depression and suicide behaviour (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003ctable id=\"Tab6\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eAssociation between Suicidal behaviour and Depression\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eSuicide behaviour\u003c/p\u003e\n \u003c/th\u003e\n \u003cth rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eX\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003edf\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSuicidal\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNon suicidal\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eDepression\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eNon-depressed\u003c/p\u003e\n \u003cp\u003eDepressed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e163 (99.4)\u003c/p\u003e\n \u003cp\u003e19 (61.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1 (0.6)\u003c/p\u003e\n \u003cp\u003e12 (38.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e60.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003e\u003cem\u003e*Fischer\u0026rsquo;s exact test was used.\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003eThe finding revealed that a substantial majority of respondents reported minimal symptoms of depression. Specifically, 64.6% did not experience a loss of interest or pleasure in daily activities. Additionally, 69.9% did not indicate feeling of depression or hopelessness, while 73.9% reported no difficulties with falling or staying asleep. More than half of the participants (51.7%) did not struggle with issues related to appetite, such as overeating or poor appetite. Furthermore, 74.2% did not encounter challenges with concentration, such as difficulties in reading the newspaper or watching television. Notably, 81.8% of respondents did not consider death or self-harm as preferable options. These results suggest a relatively low prevalence of significant depressive symptoms within this population, indicating potential resilience among the students (Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\n\u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eAs found by this study, 63% of in-school adolescents experience minimal depression, 26.1% experience mild depression, 8.9% experience moderate depression, 1.3% experience moderately severe depression and 0.8% experience severe depression. This is similar to findings by Adeniyi et al. (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2011\u003c/span\u003e), who reported a 5.7% prevalence of major depressive symptoms and 23.8% of mild-to-moderate symptoms among Nigerian adolescents. On the other hand, presence of suicidal behavior was reported by 6.1% of respondents which exactly tallies with the findings by Adewuya et al. (2021) which found a weighted 1-month prevalence of 6.1% for suicidal ideation, 4.4% for suicidal plan and 2.8% for suicidal attempt within the same Nigerian context.\u003c/p\u003e \u003cp\u003eSignificantly associated with the prevalence of depression and suicidal behavior was the \u0026ldquo;type of school attended\u0026rdquo;, with public school attendees 6.40 times likelier to be depressed and 3.76 times likelier to have suicidal behaviors than private school attendees. Similar studies by Singh et al. (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2017\u003c/span\u003e) in India and Rowland et al. (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) in Australia also found the school-type is a significant predictor of depression and suicidal symptom among adolescents. In India this disparity was attributed to factors like lower family income and socio-economic standard of public-school attendees as well as the limited school\u0026rsquo;s support system available to them, as compared to private schools. In Australia, the overt tradition and practice of care, support and associations within the catholic schools as against public and private schools, were posited as supportive factors against depression and suicidal behaviors among in-school adolescents (Rowland et al. \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe second factor associated with depression and suicidal behaviors as identified by this study was \u0026ldquo;frequency of beating by parent\u0026rdquo;. Adolescents who were always beaten by their parents were 3.18 times likelier to experience depression and 6.67 times likelier to exhibit suicidal behaviors, as compared to their counterparts who were seldomly beaten. To illustrate this, a large-scale study of 8,316 adults found that spanking in childhood was associated with moderate to heavy drinking, drug use and suicide attempts in adulthood (Afifi et al. 2017), which is consistent with a similar finding made by Gong et al. (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) in China. A meta-analysis on the consequences of corporal punishments in general on children, found its strong association with indicators of poor mental health including depression and suicide (Visser et al. \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Ferguson \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). Countries that have not enacted national bans on corporal punishment have been reported to experience higher rates of adolescent suicide compared to countries that have fully banned it (Laura et al. 2023).\u003c/p\u003e \u003cp\u003eAn association was also found between suicidal behavior and the \u0026ldquo;class/grade of adolescent\u0026rdquo;, with adolescents in junior classes 0.15 times more likely to exhibit suicide behaviour compared to their counterpart in senior classes. A longitudinal study of African American adolescents by Whipple et al. (\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) in the US found that 30% of them experienced high suicidal ideation at some points between their 9th and 10th grade. This corroborates a previous study by the Center for Disease Control [CDC] in 2019 which tagged the suicide rate of African American Adolescents as \u0026ldquo;high risk\u0026rdquo;, with an alarming 12.9% of 9th grade youth attempting at least one suicide the previous year (CDC 2019). As also observed by reports from the National Substance Abuse and Mental Health Service Administration, 2006), the odds of depression and suicide increases as one progresses through life.\u003c/p\u003e \u003cp\u003eDepression has been reported as the most common \u0026ldquo;symptom\u0026rdquo; of suicide in adolescents and is highly prevalent among persons with suicidal ideations and attempts (Shaffer et al. \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e1996\u003c/span\u003e; Gould 1998), which is consistent with the finding from this study which showed a significant association between depression and suicidal behavior. Alongside other mental health conditions like anxiety and stress, depression has been found to have the most contribution and a major predictor of suicidal behavior among children and adolescents (Gledhill and Hodes \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2010\u003c/span\u003e; Izadinia et al. \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2010\u003c/span\u003e). However, there are empirical evidences that supports that child aversities including low social support, maternal depression, sexual abuse and domestic violence influences are risk factors for both depression and suicidal behaviors during adolescence (Boden et al. \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2007\u003c/span\u003e; Enns et al. \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2006\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cem\u003eStrengths and limitations\u003c/em\u003e \u003c/p\u003e \u003cp\u003eThis study was subjected to several limitations that need to be acknowledged. First, the study used a self-reported survey. This study may have raised the possibility of recall bias and social desirability bias. The data collectors team tried to minimize students\u0026rsquo; misunderstanding by explaining the content prior data collection. Mixed-methods research should be conducted in the future to obtain qualitative responses from the participants that could be used as supplementary information. Second, since this was a cross-sectional study, the nature of this research design makes it impossible to show a cause-and-effect association between the variables. The findings of this study support the recommendation for longitudinal research to be conducted in the future to provide better understanding regarding our identified predictors.\u003c/p\u003e \u003cp\u003eApart from these disadvantages, our study has several strengths. Firstly, this current study provides up-to-date evidence on suicidal behavior and depression among adolescents Benin City, Edo state, Nigeria. Secondly, our study recruited students from both private and public high schools. A significant regionally representative non-clinical sample and high participation rate in the survey could be considered as the strengths of primary importance of the current study. It allowed us to obtain a sample size with diverse sociodemographic backgrounds, increasing the generalizability of the study population. Thus, this study provides information that can serve as a building block for further studies.\u003c/p\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eResults from this study show that very few in-school adolescents experience moderate and severe forms of depression while majority experience minimal and mild levels. The experience of suicidal behavior was also reported low at 6.1% among in-school adolescents. Two distinctive factors i.e., type of school attended and frequency of beating were found as major predictors of depression and suicidal behavior among in-school adolescents. Another peculiar predictor of suicidal behavior was the class/grade of adolescent. Greater risk was found among adolescents in higher classes than in lower classes. Finally, depression was indicated as the most common symptom/indicator of suicidal behavior among in-school adolescents. This suggests that in reducing the tendencies for suicidal behaviors, risk of depression must be addressed among in-school adolescents.\u003c/p\u003e \u003cp\u003e \u003cem\u003eRecommendations\u003c/em\u003e \u003c/p\u003e \u003cp\u003eIn line with study findings, it is recommended that psychosocial support system be institutionalized and strengthened in particularly public schools across Nigeria. This is coupled with the fact that public schools host more pupils and students as against private schools. According to Sasu (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) 22.7\u0026nbsp;million children are hosted in public schools and 5.4\u0026nbsp;million in private schools. The practice of corporal punishment both in schools and homes should be discouraged through awareness-raising and attitudinal change interventions for parents and teachers. Constructive reward and punishment systems should be identified and adopted for especially adolescents as against physical battery. With depression as a major indicator for suicidal behavior among adolescents, it is recommended that awareness and education programs be designed for students both formally and informally, to equip them with knowledge and skills for prevention, reporting and recovery. A proposed direction for further research is to examine the roles of teachers and parents in addressing depression and suicidal tendencies among adolescents in Nigeria.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAboagye RG, Ahinkorah BO, Seidu AA, Okyere J, Frimpong JB, Kumar M (2022) In-school adolescents' loneliness, social support, and suicidal ideation in sub-Saharan Africa: Leveraging Global School Health data to advance mental health focus in the region. 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Department of Mental Health and Substance Abuse, World Health Organization, In. Geneva\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Central South University","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Adolescent, Depression, Nigeria, Predictors, Secondary schools, Suicidal behaviour","lastPublishedDoi":"10.21203/rs.3.rs-5751576/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5751576/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eAim: \u003c/strong\u003eThis study investigates the prevalence and determinants of depression and suicidal behavior among secondary school adolescents in Edo State, Nigeria.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSubject and Methods: \u003c/strong\u003eA descriptive, cross-sectional study was conducted with 621 in-school adolescents, selected through multistage random sampling. Depression and suicidal ideation were assessed using the Patient Health Questionnaire-9 (PHQ-9) and Suicidal Behavior Questionnaire-Revised (SBQ-R). Statistical analyses, including chi-squared tests, Fisher’s exact tests, and logistic regression, explored correlations, with significance set at \u003cem\u003ep \u0026lt;\u003c/em\u003e 0.05\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eAmong participants, 26.09% reported mild depressive symptoms, while 10.9% exhibited moderate-to-severe symptoms; 6.1% had suicidal ideation. Depression risk factors included school type, residential area, and frequency of parental discipline. Adolescents in public schools had a 5.03 times higher likelihood of depression compared to their private school counterparts (AOR: 5.03; CI: 2.02–12.54), and those frequently disciplined by parents were 3.18 times more likely to experience depression (OR: 3.18; CI: 1.30–7.81). Senior students showed a higher risk of suicidal behavior (OR: 0.15; CI: 0.07–0.34), as did those in public schools (OR: 3.67; CI: 1.70–8.37) and those frequently punished (OR: 6.67; CI: 2.15–20.73). Depression and suicidality were strongly correlated (\u003cem\u003ep\u003c/em\u003e ≤ 0.01).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e The notable rates of depression and suicidal behavior in Nigerian adolescents underscore the need for targeted mental health interventions. Establishing support structures and policy interventions in schools and communities could help identify and support at-risk adolescents, reducing the risk of adverse mental health outcomes.\u003c/p\u003e","manuscriptTitle":"Predictors of depression and suicidal behaviors among in-school adolescents in Nigeria: A Cross-sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-01-06 14:32:47","doi":"10.21203/rs.3.rs-5751576/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6724b7f0-8285-4d5c-a61e-ab79d69f9010","owner":[],"postedDate":"January 6th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":42432716,"name":"Psychology"},{"id":42432717,"name":"Epidemiology"},{"id":42432718,"name":"Educational Psychology"},{"id":42432719,"name":"School Counseling"}],"tags":[],"updatedAt":"2025-01-22T12:54:20+00:00","versionOfRecord":[],"versionCreatedAt":"2025-01-06 14:32:47","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5751576","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5751576","identity":"rs-5751576","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}